ANEMIA - literal translation from Greek - bloodlessness, anemia (anaemia, "an" - without, "haima" - blood), in the clinical sense: Anemia - a pathological condition characterized by a decrease in hemoglobin content, often in combination with a decrease in the number of erythrocytes per unit blood volume .
Iron deficiency anemia (sideropenic anemia) -
a pathological condition characterized by a decrease in hemoglobin content from
for iron deficiency in the body as a result of a violation of its receipt, absorption or its pathological loss
Iron deficiency anemia, unlike most other anemias, is often not accompanied by a decrease in the content of red blood cells per unit volume of blood.
2.2. The frequency of iron deficiency anemia in children.
Iron deficiency anemia is widespread in the pediatric population and is the most common form among all anemia of childhood. According to WHO (1985), iron deficiency, in varying degrees of severity, is present in almost 30% of the world's population. The greatest risk of developing iron deficiency anemia, especially at developing countries, and this is emphasized by the majority of researchers, have children of early and puberty, as well as women of childbearing age (Table 4)
Iron deficiency anemia in children is a type of deficiency anemia, which is based on absolute or relative iron deficiency in the body. The prevalence of iron deficiency anemia among children of the first 3 years of life is 40%, among adolescents - 30%, among women of reproductive age - 44%. Without exaggeration, it can be stated that iron deficiency anemia is the most frequent form that specialists in the field of pediatrics, obstetrics and gynecology, therapy, and hematology face.
During fetal development, iron enters the baby’s body from the mother through the placenta. The most enhanced transplacental transport of iron occurs between the 28th and 32nd weeks of gestation. By the time of birth, the body of a full-term baby contains 300-400 mg of iron, premature - only 100-200 mg. In a newborn, the consumption of neonatal iron occurs on the synthesis of Hb, enzymes, myoglobin, regeneration of the skin and mucous membranes, compensation of physiological losses with sweat, urine, feces, etc. Rapid growth and development of young children cause an increased need of the body for iron. Meanwhile, the increased use of iron from the depot leads to a rapid depletion of its reserves: in full-term babies by the 5-6th month of life, in premature babies - by the 3rd month.
For normal development, the daily ration of a newborn should contain 1.5 mg of iron, and the diet of a child of 1-3 years should be at least 10 mg. If the loss and expenditure of iron prevail over its receipt and absorption, the child develops iron deficiency anemia. The lack of iron and iron deficiency anemia in children contributes to the hypoxia of organs and tissues, reduced immunity, increased infectious morbidity, impaired neuropsychological development of the child.
Causes of iron deficiency anemia in children
Antenatal and postnatal factors may be involved in the development of iron deficiency anemia in children.
The antenatal factors include the lack of iron depot formation in the prenatal period. In this case, iron deficiency anemia usually develops in children under the age of 1.5 years. Toxicosis, anemia of a pregnant woman, infectious diseases of a woman during gestation, the threat of miscarriage, placental insufficiency, placental abruption, multiple pregnancy, premature or late ligation of the umbilical cord in a child can contribute to the early development of anemia in a child. The most susceptible to the development of iron deficiency anemia are children born with a large mass, premature, with lymphatic-hypoplastic diathesis.
Postnatal iron deficiency anemia in children is associated with factors acting after the birth of a child, primarily the lack of iron intake from food. At risk for the development of iron deficiency anemia are children who receive artificial feeding unadapted milk mixtures, goat or cow's milk. The nutritional causes of iron deficiency anemia in children also include the late timing of the introduction of complementary foods, the lack of animal protein in the diet, unbalanced and poor nutrition of the child at any age.
External and internal bleeding (gastrointestinal, into the abdominal cavity, pulmonary, nasal, traumatic), heavy menstruation in girls, etc. can lead to iron deficiency anemia in children. Iron deficiency is associated with diseases occurring with a violation of the absorption of trace elements in the intestines: diseases Crohn’s disease, ulcerative colitis, Hirschsprung disease, enteritis, intestinal dysbiosis, cystic fibrosis, lactase deficiency, celiac disease, intestinal infections, giardiasis, etc.
Excessive loss of iron is observed in children suffering from allergic skin manifestations, frequent infections. In addition, the cause of iron deficiency anemia in children can be a violation of iron transport due to reduced content and insufficient activity of transferrin in the body.
Symptoms of iron deficiency anemia in children
The clinic of iron deficiency anemia in a child is non-specific and can occur with a predominance of astheno-vegetative, epithelial, dyspeptic, cardiovascular, immunodeficient, hepatolienal syndrome.
Astheno-vegetative manifestations in children with iron deficiency anemia are caused by the hypoxia of organs and tissues, including the brain. At the same time, there may be marked hypotonia, a child’s lag in physical and psychomotor development (in severe cases - intellectual insufficiency), tearfulness, irritability, vegetative-vascular dystonia, dizziness, orthostatic collapses, fainting, enuresis.
Epithelial syndrome in children with iron deficiency anemia is accompanied by changes in the skin and its appendages: dry skin, hyperkeratosis of the skin of the elbows and knees, cracks in the oral mucosa (angular stomatitis), glossitis, heylitis, dullness and active hair loss, weakness and cleansing and cleansing and exhaustion. .
Dyspeptic symptoms in children with iron deficiency anemia include loss of appetite, anorexia, dysphagia, constipation, flatulence, diarrhea. Characteristic changes in the sense of smell (addiction to the sharp odors of gasoline, varnishes, paints) and taste (the desire to eat chalk, earth, etc.). The defeat of the gastrointestinal tract leads to disruption of iron absorption, which further aggravates iron deficiency anemia in children.
Changes in the cardiovascular system occur with severe iron deficiency anemia in children and are characterized by tachycardia, shortness of breath, hypotension, cardiac noise, myocardial dystrophy. Immunodeficiency syndrome is characterized by a prolonged unmotivated subfebrile condition, frequent acute intestinal infections and acute respiratory viral infections, severe and prolonged infections.
Hepatolienal syndrome (hepatosplenomegaly) usually occurs in children suffering from severe iron deficiency anemia, rickets and anemia.
Diagnosis of iron deficiency anemia in children
In the diagnosis of iron deficiency anemia and its causes in children, various specialists are involved: a neonatologist, pediatrician, hematologist, pediatric gastroenterologist, pediatric gynecologist, etc. On examination of a child, the presence of pallor of the skin and visible mucous membranes (oral cavity, conjunctiva), acrocyanosis or perioral mucous membranes and perioral mucosal pores, acne or perioral mucous membranes (oral cavity, conjunctiva), acrocyanosis or perioral mucous membranes (perioral cavity, conjunctiva), acrocyanosis or perioral mucosa (perioral mucous membranes), acrocyanosis or perioral mucous membranes (oral cavity, conjunctiva), acrocyanosis or perioral mucous membranes (perioral cavity, conjunctiva), acrocyanosis or perioral mucosa (perioral mucous membranes) dark circles under the eyes.
The most important laboratory criteria for judging the presence and degree of iron deficiency anemia in children are: Hb (63), serum ferritin (
To determine the factors and causes of concomitant iron deficiency anemia in children, bone marrow puncture, fibrogastroduodenoscopy, colonoscopy, abdominal ultrasound, pelvic ultrasound, gastric x-ray, irrigoscopy, fecal dysbacteriosis, occult blood, helminth eggs and protozoa may be required. .
Treatment of iron deficiency anemia in children
The main principles of treatment of iron deficiency anemia in children include: eliminating the causes of iron deficiency, correction of the regimen and diet, the appointment of iron preparations.
The diet of children suffering from iron deficiency anemia should be enriched with foods rich in iron: liver, veal, beef, fish, egg yolk, legumes, buckwheat, oatmeal, spinach, peaches, apples, etc.
Elimination of iron deficiency in the child’s body is achieved by taking iron supplements. It is convenient for young children to prescribe iron preparations in the form of liquid dosage forms (drops, syrups, suspensions). Iron preparations should be taken 1-2 hours before eating, with water or juices. In the complex therapy of iron deficiency anemia in children, it is necessary to include vitamin-mineral complexes, adaptogens, herbal preparations, homeopathic preparations (as prescribed by the children's homeopath).
In case of severe iron deficiency anemia, children are given parenteral administration of iron preparations, red blood cell transfusions.
The main course of treatment for iron deficiency anemia in children is usually 4–6 weeks, while supportive treatment is another 2–3 months. Simultaneously with the elimination of iron deficiency, it is necessary to treat the underlying disease.
Prognosis and prevention of iron deficiency anemia in children
Adequate treatment and elimination of the causes of iron deficiency anemia in children leads to the normalization of peripheral blood counts and the full recovery of the child. In children with chronic iron deficiency, there is a lag in physical and mental development, frequent infectious and somatic morbidity.
Antenatal prophylaxis of iron deficiency anemia in children consists in the intake of ferrodrugs or multivitamins by the pregnant woman, the prevention and treatment of the pathology of pregnancy, nutrition and the regime of the future mother. Postnatal prevention of iron deficiency anemia in children involves breastfeeding, the timely introduction of the necessary complementary foods, the organization of proper care and treatment of the child. Prophylactic iron supplementation is indicated for premature babies, twins, children with anomalies of the constitution, children in periods of rapid growth, puberty, adolescent girls with heavy menstruation.
Medical expert articles
Iron deficiency anemia in children is a clinical and hematological syndrome, based on a violation of hemoglobin synthesis due to iron deficiency.
3 iron deficiency states are described:
- iron deficiency
- latent iron deficiency,
- Iron-deficiency anemia.
In case of iron deficiency, the iron content is reduced only in the depot while maintaining transport and hemoglobin funds. The absence of clinical manifestations and clear diagnostic criteria make it possible not to attach practical importance to this state.
The latent deficiency of iron, constituting 70% of all iron-deficient conditions, is considered not as a disease, but as a functional disorder with a negative iron balance, it does not have an independent code for ICD-10. With latent iron deficiency, a characteristic clinical picture is observed: sideropenic syndrome, but the hemoglobin content remains within normal limits, which does not allow identifying individuals with this condition from the general population according to this laboratory parameter.
Iron deficiency anemia in children (ICD-10 code - D50) is a disease, an independent nosological form, constituting 30% of all iron deficiency states. With this disease reveal:
- anemic and sideropenic syndromes,
- decrease in hemoglobin and serum iron concentrations,
- increase in the total iron binding capacity of serum (OZHSS),
- decrease in the concentration of serum ferritin (SF).
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Important frequency response: 90% of anemia in children is iron deficiency anemia, in adults this figure reaches 80%. The remaining 10% (in adults 20%) are attributed to other types of anemia: hereditary and acquired hemolytic anemias, constitutional and acquired aplastic anemias. The true figures of the incidence and prevalence of iron deficiency anemia in children in our country are unknown, but most likely are quite high, especially in young children. The magnitude of the problem can be assessed by considering the WHO data: 3,600,000,000 people on earth have a latent iron deficiency and 1,800,000,000 people suffer from iron deficiency anemia.
Iron deficiency anemia can be called a socially significant disease. The prevalence of iron deficiency anemia in children aged 2.5 years in Nigeria is 56%, in Russia - 24.7%, in Sweden - 7%. According to WHO experts, if the prevalence of iron deficiency anemia exceeds 30%, this problem goes beyond the scope of medical care and requires decision-making at the state level.
According to official statistics of the Ministry of Health of Ukraine, in Ukraine there is a significant increase in the incidence of anemia in children and adolescents.
In childhood, iron deficiency anemia constitutes 90% of all anemias. Thus, prescribing iron supplements for all anemias, the doctor "guesses" in 9 cases out of 10. The remaining 10% of anemias include congenital and acquired hemolytic and aplastic anemias, as well as anemia in chronic diseases.
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The exchange of iron in the body
Normally, an adult healthy person’s body contains about 3-5 grams of iron, so iron can be classified as trace elements. Iron is unevenly distributed in the body. Approximately 2/3 of the iron is contained in the hemoglobin of the erythrocytes - this is a circulating fund (or pool) of iron. In adults, this pool is 2-2.5 g, in full-term infants - 0.3-0.4 g, and in preterm infants - 0.1-0.2 g.
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Pathogenesis of iron deficiency anemia
In the development of anemia there is a certain sequence:
Stage I - decrease stocks gland in the liver, spleen and bone marrow.
In parallel, the concentration decreases ferritin in serum, a latent iron deficiency develops - sideropenia without anemia. According to modern concepts, ferritin reflects the state of total iron reserves in the body, so at this stage iron reserves are significantly depleted without a decrease in the erythrocyte (hemoglobin) pool.
Iron deficiency in children in the first year of life and early age
The idea that a decrease in hemoglobin concentration in a pregnant woman does not affect the development of the fetus is erroneous. Iron deficiency in the fetus leads to irreversible damage:
- brain mass growth
- the process of myelination and nerve impulses through synapses.
These changes are irreversible; they cannot be corrected with iron preparations prescribed in the first months of a child's life. Subsequently, the child noted a delay in mental and motor development, impaired cognitive functions. American researchers have shown that even 5 years after iron-deficiency anemia, transferred between the ages of 12-23 months, a child is noted to have a delay in mental and motor development, as well as learning difficulties.
The most intensive growth is observed in children under one year and in adolescents in the puberty period. Pediatricians know that at the age of 3 months, many children show a reduced level of hemoglobin (105-115 g / l).This phenomenon was also registered by American doctors and served as the basis for the development of appropriate recommendations. For children aged 3 months, the lower limit of the hemoglobin concentration was established, corresponding to 95 g / l, since this is a transient decrease in hemoglobin level expressed in the majority of children in the population. The decrease in hemoglobin concentration in most children at 3 months associated with the transition of erythroid cells from the synthesis of fetal hemoglobin (Hb F) to Hb A2 represents “physiological anemia” and does not require treatment. The hemoglobin concentration should be determined at 6 months: at this age, its values correspond to the norm (110 g / l and more).
If the baby is breastfed and does not belong to any risk group (prematurity, from a multiple pregnancy, born with a low body weight), breastfeeding continues and the baby is monitored. The administration of iron preparations in prophylactic doses, usually constituting 50% of the therapeutic dose, is indicated to children from the indicated risk groups for the development of iron deficiency anemia.
Continuous monitoring of hemoglobin content should be carried out up to 18 months:
- in children with low birth weight,
- in premature babies,
- in children not receiving milk formulas containing iron.
From the 6th to the 18th month, hemoglobin levels should be monitored if the child:
- gets cow's milk up to 12 months,
- breastfeeding after 6 months receives an insufficient amount of iron with lure,
- ill (chronic inflammatory diseases, dietary restrictions, excessive blood loss due to injury, taking drugs that interfere with the absorption of iron).
Iron deficiency anemia in adolescents
Adolescents, especially girls 12-18 years old, need to be screened for hemoglobin content. It is advisable to determine the annual level of hemoglobin in girls and women with heavy blood loss during menstruation or other nature, low intake of iron from food, and iron deficiency anemia in history. Non-pregnant people who do not belong to these risk groups do not need frequent monitoring of hemoglobin content and can be examined every 5 years if they eat foods rich in iron and enhancing its absorption. Young men also need to control hemoglobin levels if they are intensively engaged in hard sports (anemia of athletes). If an iron deficiency anemia is detected, it is treated.
Prophylactic vaccination in children with iron deficiency anemia is not contraindicated, does not require the normalization of hemoglobin level, since the number of immune competent cells is sufficient.
Russia can and should draw on the experience of combating iron deficiency anemia obtained in other countries. The most clearly defined measures for the prevention of iron deficiency states are formulated in the national "Recommendations for the prevention and treatment of iron deficiency in the United States" (1998): primary prevention implies proper nutrition, secondary - active detection of latent iron deficiency and iron deficiency anemia during medical examination, medical check-ups and visits to a doctor.
Treatment of iron deficiency anemia by red blood cell transfusions
Red blood cell transfusion is not recommended even in cases of severe IDA, since it develops gradually, and the child adapts to anemization.
Transfusions are warranted, if only:
- it is necessary for vital indications, with severe anemic syndrome (Hb below 50 g / l),
- the patient needs urgent surgical intervention or an urgent examination under anesthesia.
If necessary, the erythrocyte mass is injected at the rate of 3-5 mg / kg per day (maximum 10 mg / kg per day) - intravenously slowly, every other day, until the hemoglobin concentration is reached which will reduce the risk of surgery. One should not strive to quickly correct severe anemia, since there is a risk of hypervolemia and heart failure.
Contraindications to the appointment of iron
Absolute contraindications to the appointment of AF are:
- acute viral and bacterial infectious diseases,
- diseases associated with iron cumulation (hemochromatosis, hereditary and autoimmune hemolytic anemia),
- diseases involving a violation of iron utilization (sideroblastic anemia, alpha- and beta-thalassemia, anemia in lead poisoning),
- diseases associated with bone marrow insufficiency (aplastic anemia, Fanconi anemia, Blackfan Diamond, etc.).
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Unwanted effects and complications when using iron supplements
When using oral OP, side effects associated with both the chemical properties of iron salts and hypersensitivity to individual components of drugs are rare.
Manifestations of side effects are:
- metallic taste in the mouth
- darkening of the teeth and gums,
- epigastric pain,
- dyspeptic disorders due to irritation of the gastrointestinal mucosa (nausea, belching, vomiting, diarrhea, constipation),
- dark staining stools
- allergic reactions (usually by the type of urticaria),
- necrosis of the intestinal mucosa (overdose or salt poisoning with FP).
These effects can be easily prevented by strictly observing the correct dosing regimen and taking the drug. First of all, this refers to the group of salt OP. It is advisable to begin treatment with a dose equal to 1/2 - 2/3 of the therapeutic one, followed by gradual achievement of the full dose within 3-7 days. The rate of "increasing" the dose to the therapeutic depends on both the degree of GI and the individual tolerance of a particular drug by the child. Salt OP should be taken between meals (approximately 1-2 hours after, but no later than 1 hour before meals), drinking a small amount of fruit juice with pulp. Do not drink salt OP tea or milk, as they contain components that inhibit the absorption of iron. Darkening of the teeth and gums can also be avoided if the drug is given in diluted form (for example, fruit juice) or on a piece of sugar. Allergic reactions are usually associated with other components that make up complex drugs; in this case, it is necessary to change AF. Necrosis of the intestinal mucosa develops in extremely rare cases of overdose or poisoning with saline AF. Dark staining of the stool has no clinical significance, but it is necessary to warn the parents of the child or himself if this is already the case when he performs the hygienic procedures on his own. By the way, this is a very good and effective way to check if your patient is taking AF.
Preparations of iron (III) -hydroxide polymaltozate are practically devoid of side effects. In addition, due to the lack of interaction with food components in this group of AF, children do not need to adhere to any dietary restrictions, and the treatment is started immediately from the calculated therapeutic dose.
In the event of side effects, you should either reduce the dose of AF, or replace it with another.
With the introduction of parenteral AF is rare, but there may be side effects: sweating, taste of iron in the mouth, nausea, asthma, tachycardia, fibrillation, which requires the abolition of AF. Local reactions (hyperemia, soreness, venous spasm, phlebitis, darkening of the skin and abscesses at the injection site), allergic reactions (urticaria, angioedema) can be extremely rarely observed.
The most serious life-threatening complication is poisoning with iron salts (60 mg / kg or more for elemental iron). The severity of the condition and the prognosis depend on the amount of iron absorbed. The clinical manifestations of acute overdose with iron salts are sweating, tachycardia, CNS depression, collapse, shock. Allocate 5 phases of poisoning with iron salts.
Why does a child's body need iron?
Iron is one of the most important trace elements in the children's body. Without it, the synthesis of enzymes and proteins that are involved in metabolic processes is impossible.
Iron is part of a protein like hemoglobin. It is this protein that is responsible for transporting oxygen to organs and tissues. If there is not enough iron, then the hemoglobin content will decrease in the blood. This provokes hypoxia (oxygen starvation) of all systems of the human body. Especially acutely to the lack of oxygen react brain tissue.
Iron is found in myoglobin, catalase, cytochrome peroxidase, as well as a number of other enzymes and proteins. Also in the body there is a depot of this microcell. Iron is stored in it in the form of ferritin and hemosiderin.
When the baby is still in the womb, it receives iron through the placenta. Most iron baby is required from 28 to 32 weeks. It is at this time that the depot of this trace element is formed.
When a child is born, in his body should be 300-400 mg of iron, which is stored in stock. If the baby is born ahead of schedule, then these numbers are much smaller and amount to 100-200 mg.
The body of the child will spend this iron on the production of hemoglobin and enzymes, it takes part in the processes of tissue repair, in general, is spent on it to ensure the needs of the body.
The baby grows very quickly, which causes a high need for his body in the gland. Therefore, the stocks that he had at birth, will end very quickly. If the child was born on time, then these stocks will be exhausted by 6 or even by 5 months. If the baby was born too early, then the iron will be enough for him only up to 3 months of independent life.
Iron that is supplied from the outside is absorbed in the duodenum and in the jejunum. However, from all the amount that a person receives from food, no more than 5% of iron is absorbed. This process is influenced by the work of the digestive organs. The main source of iron is red meat.
Symptoms of anemia in a child
Signs of iron deficiency in a child are very diverse. There is a difference between how anemia is manifested in children 5 years old compared to how anemia is manifested in children 10 years old. Therefore, parents should have complete information on this issue, which will allow the early detection of the first symptoms of anemia and seek medical help.
There are several syndromes that characterize childhood iron deficiency anemia: epithelial, asteno vegetative, dyspeptic, immunodeficient, cardiovascular. They should be discussed in more detail.
Symptoms of epithelial syndrome. The skin is very dry, they appear cracks. The skin is very flaky, it becomes rough to the touch.
Suffer hair and nails. They become brittle, stripes appear on the nail plates. Hair fall out much.
Oral mucosa is a kind of marker that the intestines are not all right. A child’s lips and tongue may be inflamed. He also often develops stomatitis, manifestations of which become ulcers on the gums and the inside of the cheeks.
The skin itself looks unnaturally pale. And the harder the stage of the disease, the paler the child will be.
Symptoms of asteno vegetative syndrome. Asthenovegetative syndrome develops on the background of oxygen starvation of brain tissue. The child often has headaches. The muscular frame of the baby is weak. There are problems with sleep. Night rest becomes restless, sleep superficial. This negatively affects the emotional sphere of the child. He becomes whiny, capricious, apathetic, or overly excitable. His mood often changes.
Blood pressure drops are possible. If the child rises abruptly, he may even faint.
Vision deteriorates. If we compare a child with peers, he is noticeably lagging behind them in both physical and mental development.
Infant babies who develop anemia may lose the motor skills that they have already acquired. Young children are normally very active. However, developing anemia significantly reduces this activity.
The child will suffer from urinary incontinence for a long time, as his sphincter is too weak to be kept in the bladder.
Symptoms of dyspeptic syndrome. Dyspeptic syndrome is expressed in loss of appetite, sometimes adolescent children even suffer from anorexia. Kids often burp, they may have problems with swallowing food, often there is flatulence.
Some children suffer from constipation, while others suffer from diarrhea.
Parents often note that the child's taste is distorted, the baby may be craving for inedible products. For example, he has a desire to gnaw chalk or eat sand. Also, a child may like smells that are normal, disgusting. This is the smell of gasoline, paint, varnish, etc.
The spleen and liver are increasing in size, which can be detected by the doctor during a standard examination. Increases the likelihood of intestinal bleeding. In general, the organs of the digestive system work with disorders.
Symptoms of immunodeficiency syndrome. A decrease in immunity may be indicated by a prolonged increase in body temperature to the level of 37.5 ° C. The child is sick more often. Infections have a protracted course and are difficult to correct.
Symptoms of cardiovascular syndrome Cardiovascular syndrome develops only with a severe stage of anemia. The child's pulse and breathing increase, blood pressure decreases. The heart muscle undergoes dystrophic changes, and noises are heard in the heart.
Causes of development
So that the baby does not suffer from iron deficiency immediately after birth, he should receive it with food. Per day, the volume of iron coming from the outside should be equal to 1.5 mg. When a child reaches 1-3 years of age, this need increases to 10 mg. On the day of the child's body loses 0.1-0.3 mg of iron (for young children). And the cost of adolescents is 0.5-10 mg.
If a baby spends more iron than it receives from the outside, then over time it develops an iron deficiency. This condition is called iron deficiency anemia.
Causes of iron deficiency anemia in a child:
The hematopoietic system of the baby is not sufficiently developed.
He does not receive adequate nutrition.
The child has parasites.
The child is infected with the infection.
The child is in puberty. At this time, hormonal disruptions can lead to iron deficiency.
Also, a large amount of iron in the body is consumed with bleeding. They can occur during surgery, after injury. These are the most obvious causes of blood loss.
There are also internal factors that can cause bleeding:
In girls in adolescence, abundant menstrual bleeding is possible.
Also provoke a deficiency of iron in the body can some medications that the child receives. Among them: salicylates, NSAIDs, glucocorticosteroids.
Bad habits, which are often subject to adolescents, can be a triggering factor for the development of anemia. This includes alcohol and drugs, and smoking. Other risk factors are: insufficient time for rest, impaired intestinal microflora, lack of vitamins, eating foods that interfere with the normal absorption of iron.
Causes of anemia in children 1 year
In children of the first year of life, anemia can develop due to the effect on their body of negative factors both during fetal life and after the appearance of the baby in the world. The reasons that affected the child’s body during its prenatal existence are called antenatal factors.They do not allow the gland to accumulate in the body of the fetus in sufficient quantities. As a result, anemia develops in the crumbs in the period when he is still breastfed.
These factors include:
The presence of anemia in a pregnant woman.
Transferred to the future mother of infection.
Simultaneous bearing of several children.
Too early or too late cord ligation.
If the child was born with a greater weight, or, on the contrary, premature, then anemia will develop with a greater degree of probability than a healthy baby. The same is true of twins and children with developmental abnormalities.
In the period up to a year, anemia can manifest due to a number of postnatal factors, including:
Feeding a baby with milk formulas that are not adapted to the age of the crumbs.
Feeding a baby with whole cow or goat milk.
Introduction of complementary foods after the prescribed time.
Errors in the child's diet.
Disorders in the process of absorbability of iron in the intestines of the crumbs.
The baby must eat right. The best product for him is mother’s milk. Iron in it is not very much, but it is absorbed in the body of the child quickly, because it has a special form (lactoferrin). This allows immunoglobulin A to exhibit its antibacterial properties.
Classification of anemia in children
Classification of anemia in children, depending on the mechanism of the disease and its causes:
Post-hemorrhagic anemia, which is provoked by blood loss (chronic and acute).
Anemia associated with impaired blood formation:
Hereditary and acquired iron anemia.
Megaloblastic anemia associated with a deficiency of folic acid and vitamin B12.
Dizerythropoietic anemia (acquired and hereditary)
Aplastic and hypoplastic anemias against the background of oppression of blood formation.
Hereditary and acquired hemolytic anemia (autoimmune anemia, membranopathy, hemoglobinopathy, etc.).
Degrees of anemia in children
First, the child develops prenatal anemia, when the level of iron begins to decline, but it is still enough to meet the needs of the body. However, this adversely affects the activity of enzymes in the intestine. As a result, iron from food will be absorbed poorly. This is an easy stage of anemia.
The next stage in the development of anemia is a hidden iron deficiency. In this case, the depot of the body is depleted, which affects the iron content in the serum portion of the blood. The condition of a child with an average degree of anemia may be satisfactory, but pathological processes in the body will already be started.
The next stage of development of anemia is the stage of clinical manifestations. During this period, anemia can be detected by blood counts. The content of not only hemoglobin but also red blood cells falls in it.
All cells of the body begin to suffer from oxygen starvation. This negatively affects the work of internal organs. The immunity of the child begins to decline, he is sick more often and becomes susceptible to intestinal infections. Each such episode impairs the functioning of the intestines and leads to the fact that iron deficiency is increasing.
The lack of trace elements suffers from the brain of a child. He begins to lag behind in mental development from their peers. At the same time hearing and sight decrease.
Treatment of anemia in children
Pediatric anemia responds well to treatment when its cause has been established. Otherwise, the fight against the disease will be long and meaningless. If anemia develops on the background of massive blood loss, then the decision on how to treat it should be an emergency. Red blood cell transfusions are required or the child will die.
When a child has chronic blood loss, for example, in ulcerative colitis, efforts should be directed towards the elimination of the underlying disease.
With heavy menstrual flow, the girl needs to be reduced to a gynecologist's appointment. Perhaps she will need hormonal correction. You may also need the help of an endocrinologist.
If parasite eggs are found in the fecal masses, then de-worming of all family members should be carried out.
Comprehensive measures aimed at the treatment of iron deficiency anemia:
Need to adjust the menu of the child.
Obligatory actions must be observed according to the age of the child. He should spend enough time in the fresh air, engage in physical activity, go to bed on time.
On the recommendation of the doctor, the child should receive iron supplements.
Depending on the symptoms of the disease, you need to focus on eliminating them.
Diet - this is a prerequisite that allows you to get rid of anemia. The child must eat fully. The best product for an infant is mother’s milk. It contains iron, which is fully absorbed by the intestines of the crumbs.
During the first year of life, the infant's metabolic processes are very active, so the supply of iron he received from his mother is quickly depleted. In this regard, the supply of trace elements should be carried out during the introduction of complementary foods, with food.
If an infant is diagnosed with anemia, then they begin to administer the feeding up one month earlier. These children are not recommended to offer rice porridge, semolina and bearberry. Emphasis must be placed on the yachka, buckwheat and millet. Meat for babies with anemia has been offered since six months. If the baby is bottle-fed, he should receive mixtures that are additionally enriched with iron.
If a child suffers from disturbances in the work of the digestive system organs, then he may be offered herbs. It is useful to give your baby decoctions of wild rose, nettle, dill, mint, elecampane, red clover, etc. However, before starting treatment, you should consult a doctor. It is also necessary to closely monitor the body's reaction to such drinks and not to miss the development of an allergic reaction.
If anemia is diagnosed in a child older than a year, then his diet should be enriched with foods that are sources of iron, among them:
What it is
All organs and tissues in our body need oxygen. To ensure its delivery was uninterrupted, there is a red blood cell in the body - the erythrocyte. This cell is in the form of a biconcave disc, the inner contents of which are rich in hemoglobin.
Hemoglobin is a red pigment containing iron that can bind with oxygen. The main store for iron inside the cells is the protein-glandular complex ferritin. He is in almost all organs and tissues. Transferrin - proteins that transfer iron from the place of its absorption from food in the duodenum to the forming red blood cells.
When the level of iron in the body falls, the amount of hemoglobin and red blood cells decreases. Iron deficiency anemia develops in a child, previously also called anemia.
How to suspect anemia
The lack of iron and oxygen imposes its imprint and gives the child certain features. Symptoms in children develop in several groups:
Anemic manifestations (due to insufficient oxygen supply to the tissues):
- learning disruption,
- noise in ears,
- shortness of breath, palpitations,
- darkening of the eyes and even fainting.
Enzymatic (due to iron deficiency, which is part of many enzymes, their work and metabolism is disturbed).
- Skin changes: it is dryness of the skin, its peeling, with time the appearance of a jam on the lips, and in the later stages and cracks in the rectum and oral mucosa. At the same time, hair and nails become thin and brittle. On the nail plates appear longitudinal strips.
- Muscles become weaker and more tired.. Growth and physical development may be delayed. The locking muscle of the bladder does not cope with the work, which leads to involuntary urination when laughing or coughing, the urge to urinate becomes irresistible and becomes more frequent. Possible bed incontinence.
- The most formidable manifestation of muscle lesions becomes myocardial dystrophyaffecting the heart. It is her fear, trying as soon as possible to begin to treat anemia. It is associated with systolic murmur when listening to the heart, heart palpitations and possible complications such as chronic heart failure, which not only prevents the child from playing sports, but can also turn him into an invalid.
- Smell and taste are perverted. A child may begin to eat unusual things in which there is no iron, and which do not compensate for its lack (chalk, watercolors, cardboard, flour, dry pasta). He may begin to like certain, sometimes harsh smells.
- The change in the enzymatic activity of saliva has to dental caries. Atrophy of the mucous membrane of the mouth and throat makes swallowing difficult, a child can choke when eating.
- Atrophic processes begin in the mucous membranes of the stomach and intestines, which leads to loss of appetite, problems with stool, slow weight gain.
It is for this reason that breastfed infants are often abandoned by the fourth or fifth month. Mom in a panic begins to sort out different varieties of baby food. And the problem lies in the fact that in the program of rickets in an infant began anemia.
- The upper airways are also affected.. In advanced cases, it is the atrophic inflammations of the pharynx and larynx that cause chronic pathologies of the upper respiratory tract.
- The local and general immune response falls. The child is more susceptible to viral, bacterial and fungal infections.
- Bluish white eyes - The result of the defective formation of collagen fibers.
How the disease develops and the diagnosis is made
In the early stages of the latent course of the disease, the depot of iron is already depleted (low ferritin) and the transport of iron is disturbed (low transferrin), but the clinical manifestations are minimal:
- light breathlessness
- poor exercise tolerance.
The developed clinic of iron deficiency anemia already includes any signs of anemia in children from anemic and enzymatic syndromes.
To establish the diagnosis most often use a general blood test:
- It determines the levels of red blood cells and hemoglobin. In the form of the analysis performed by the analyzer, they are denoted as (RBC) and (HGB).
- Previously, there was such a criterion as a color indicator (iron deficiency anemia was considered hypochromic), but today the diagnosis of anemia in children relies on the indicators:
- McV (average red blood cell volume) and
- McH (average hemoglobin in the erythrocyte).
Their values below the norm correspond to hypochromic anemia. After the start of treatment with iron preparations, they can be within the normal range. Then anemia will be considered normochromic.
In the biochemical analysis of blood note:
- reduction of ferritin, serum iron (69 μmol per liter),
- transferrin iron saturation will also be below normal (
From year to three
Anemia in young children is also a frequent result of malnutrition. At 2 years, 3 years, a child often shows character and food addictions: he refuses certain dishes or types of food, stubbornly, or seeks only sweets.
Everyone knows the stories about babies who eat, according to mom, some cookies or completely refuse meat in favor of sausages or dumplings. However, if a full-fledged animal protein, red meat or eggs is not present on the baby’s table, additional medication prophylaxis of iron deficiency anemia will be required.
A day a child up to three years old is required with food. 7 mg of iron.
In part, the problem can be solved with the help of the same purchased cereals with the addition of iron or special enriched baby cookies. Unfortunately, the myths that green apples, buckwheat or parsley can provide the body with enough iron are just myths.
Vegetables and fruits in the diet are designed to provide us with ascorbic acid, which enhances the absorption of iron. Myoglobin of red meat remains the optimal source of iron in terms of availability and digestibility.
Vegetarianism is the conscious choice of an adult who is free to manage his life and health, but to involve a growing child in it at least frivolously.
A balanced diet should be in older children, including adolescents. For them, the iron content in food should be from 5 to 15 mg.
Disorders of iron transport due to transferrin defects can also be attributed to impaired trace element intake.
This category may include acute and chronic bleeding. With the exception of massive blood loss resulting from injury, not all bleeding can lead to anemization.
If the child broke his lip, scratched or even cut his finger, with a high degree of probability, the amount of iron in the depot will allow him to compensate and avoid anemia. Chronic blood loss should be more significant, for example, in case of small hemorrhages in the intestine:
- against the background of bacterial intestinal infections,
- early introduction of cow's milk,
- anal fissures,
- ulcerative colitis,
- with gastric ulcer or 12 duodenal ulcer.
This is especially important for children threatened by anemia:
- with a lack of iron intake,
- children from birth to the introduction of complementary foods meat.
Helminthiasis may cause damage to the intestinal mucosa and minor chronic bleeding. Hookworms, necators, whipworms directly feed on blood from the intestinal wall. Roundworm and their larvae cause mechanical damage to the mucous membrane.
Girls from the beginning of menstrual bleeding deserve special attention. They require the prescription of iron preparations for the entire period of bleeding in a therapeutic dosage as the primary prevention of anemia.
Under this item are all the problems associated with fermentopathy and intestinal diseases that impede the absorption and transport of iron. Here are the syndromes of maldigestia and malabsorption in chronic colitis, ulcerative colitis and Crohn's disease, in the program of infectious enterocolitis, dysbacteriosis (syndrome of increased bacterial contamination of the intestine), and cystic fibrosis. Lesions of the duodenum (duodenitis, giardiasis).
Premature babies are at risk because of the immaturity of the blood-forming organs and the more meager depot they get at birth.
Rapidly growing children of all ages, from babies to teenagers, also need more microelement.
Earlier, iron consumption in the foci of inflammation in chronic diseases of the upper respiratory tract, respiratory and digestive systems, kidney and urinary tract diseases, oncopathology, and itchy dermatosis also related to iron deficiency anemia. Today, this condition is isolated into anemia of chronic diseases and is considered a separate disease.
How to treat
The main goals pursued in the treatment of iron deficiency anemia in children are to eliminate the causes of iron deficiency, to restore hemoglobin and red blood cell levels, and to saturate the microelement depot. Therefore, it is fundamentally wrong to simply give a child iron supplements until hemoglobin and red blood cell levels in the blood tests reach the age norm.
Rational nutrition, taking into account the needs of the child, ridding him of infectious foci, worms, inflammatory diseases and enzymes, primary and secondary prevention (after treatment in children) are key areas that should be combined with prescribing drugs.
- The diet should contain animal proteins (red meat, beef, liver, fish, poultry, cottage cheese), vegetables and fruits, dairy products that improve iron absorption.
- Beans, nuts, strong tea and coffee, which prevent iron absorption from the intestines, are limited.
When choosing drugs, the advantage is recognized for forms for oral administration (drops, tablets, capsules, syrups). These forms are more natural than injections to fill the glandular deficiency.
Since it is also necessary to saturate the depot, then anemia:
- 1 degree in a child (mild) requires a course for 3 months,
- moderate severity - 4.5 months,
- heavy - six months.
If iron deficiency anemia has developed in children, the treatment should be rationally administered with trivalent iron salts, which allow starting the treatment with the required dose. Do not irritate the intestines and are better tolerated than ferrous iron.
What preparations contain 3 x valence iron
|Syrup, drops, solution|
Depending on the goal of therapy, the child should receive these drugs (Federal clinical guidelines for the management of anemia in children):
- in the treatment of anemia at a dose of 5 mg per kg of body weight per day.
- in sideropenic syndrome (latent iron deficiency) half the dose from the calculated one.
- for the prevention of iron deficiency in children under 3 years old - 1.5 mg Fe per kg. the weight of a child older than 3 years - 1/2 of the therapeutic dose.
Ferrous Iron Preparations
|Fenulas (45 mg of iron in 1 capsule)||A multivitamin containing iron, folic acid and vitamin C. It is produced in capsules and therefore does not cause severe irritation of the stomach and mucous membranes.|
|Ferro-Folgamma (37 mg of iron + 5 mg of folic acid + 0.01 mg of vitamin B12 + 100 mg of vitamin C||Gelatin capsules with vitamin C and folic acid|
|Totem (5 mg of iron in 5 ml of oral solution)||Iron supplement with the addition of manganese and copper. Available in capsules for oral administration (10 ml of 20 pieces per pack).|
|Aktiferrin (34.5 mg of iron in a capsule, 9.48 mg in 1 ml of oral solution, 34 mg in 5 ml of syrup).||Contains serine, which improves iron absorption.|
To calculate the doses of these funds take into account not only the weight but also the age of the child.
- Up to 3 years - 3 mg per kg of body weight per day,
- Older than 3 years - 45-60 mg per day,
- Teenagers up to 120 mg per day.
Prescribed medication dosage and form of administration, depending on the age of the child:
|Up to 3 years||3 to 6 years||From 7 years and older|
Indications for injection therapy
- Severe anemia.
- Intolerance of tablets, syrups or solutions for oral administration.
- The lack of effect of treatment with oral medications.
- The presence of gastric ulcer or 12 duodenal ulcer or operations on the gastrointestinal tract.
- Chronic bowel disease (UC, Crohn's disease).
- Renal failure before or during dialysis.
- Contraindications or refusal of parents to transfuse red blood cells.
- For rapid iron saturation.
If severe anemia develops, which occurs no more frequently than in 3% of cases, treatment may require red blood cell transfusions in children.
How to evaluate the effectiveness of treatment?
- By 3 weeks of therapy, reticulocytes increase in the blood test, and hemoglobin can increase smoothly and stepwise.
- At 3-4 weeks hemoglobin should rise in the blood.
- After 2 months, the symptoms of anemia in a child should decrease.
After normalization of hemoglobin, it is impossible to stop treatment abruptly, since hemoglobin will decrease quite quickly again. With early withdrawal of drugs, recurrences of anemia occur in the coming months. Therefore, after the recovery of hemoglobin in the blood, continue therapy in 1/2 therapeutic dose.
One of the main signs of the effect of iron medication is the disappearance or reduction of muscle weakness. This is explained by the fact that Fe is part of the enzyme complexes involved in muscle contraction.
What side effects are possible with admission?
When taking iron supplements, feces turn black. This is normal and not dangerous. After discontinuation of the drug, the stool color is normalized within 2-3 days.
The treatment may develop side effects, which in some cases require replacement of the drug, the dose or change in the multiplicity of reception
- Salt forms of drugs at the beginning of their reception can loosen the stool. Therefore, starting with 1/4 or 1/2 of the calculated dose for 2 weeks, the rate of increase in dose to treatment depends on the state of the child's gastrointestinal tract and the level of iron deficiency.
- Preparations of 2-valent Fe interact in the gastrointestinal tract with food and liquids, which complicates the absorption of iron. Therefore, they are taken one hour before meals.
- Preparations of 3-valent Fe do not require a change in the initial dosage, since food does not affect the absorption of iron and their intake is shown in full dose, regardless of the meal.
When it is necessary to give drugs for prevention
Prevention of anemia in children is carried out according to the following schemes:
- Full-term infants breastfed or mixed (breastfed at least 2/3) from 4 months before the introduction of the first complementary foods need an additional 1 mg of iron per kg of body weight per day.
- Artificialists on mixtures enriched with iron do not need preparations. Those who eat low-iron mixtures are tactics from the previous paragraph.
- Premature babies with breastfeeding need 2 mg of iron per kg of body weight per day from 1 month prior to the introduction of sludge before feeding to mixtures enriched with iron.
- Prevention is carried out on a mandatory basis in menstruating girls with any oral medication in a therapeutic dose throughout all the days of menstruation.
- Children with high risks of anemia (low socioeconomic status, vegetarianism, animal protein allergies, gastrointestinal diseases, rapid growth, etc.) should undergo a screening survey once a year and donate blood from a finger.
After an episode of anemia, the child is under medical observation for a year.
Prescribing treatment, choosing drugs is a matter of competent pediatrician. The task of the mother is the organization of rational nutrition of the baby and timely access to a doctor if the disease is suspected.